Erosive pustular dermatosis (EPD) is a rare cutaneous inflammatory disease with unknown etiology characterized by chronic sterile pustules, erosions, and crusted lesions, generally confined to the scalp with subsequent cicatricial alopecia. Erosive pustular dermatosis may be preceded by local trauma or arise de novo, most often occurring in chronically actinic damaged scalp skin. The pustular component may mimic infection, but bacterial infection is believed to be a secondary process. Bacterial cultures, Tzanck smears, and biopsies are included in a typical evaluation, with a diagnosis of exclusion being made based on clinical and histopathologic grounds. Wound care and topical steroids are typically first-line therapy. Anecdotal reports describe partial responses of EPD to isotretinoin, oral dapsone, oral steroids, zinc gluconate, topical fusidic acid, nimesulide, calcipotriol, topical tacrolimus, and methylaminolevulinate –photodynamic therapy (PDT). Treatment with topical 5-aminolevulinic acid has not been described. We present a case of EPD of the scalp successfully treated with aminolevulinic acid –PDT.
Figure 1. A 72-year-old man with erosive pustular dermatosis crusted scalp lesions, before treatment with photodynamic therapy treatment.
Figure 2. Erosive pustular dermatosis with crusts removed, before treatment with photodynamic therapy.
Figure 3. Postincubation with Wood's lamp examination, demonstrating aminolevulinic acid uptake in areas of greatest inflammation.
Figure 4. The patient 12 weeks after photodynamic therapy.
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